|Número de publicación||US7905828 B2|
|Tipo de publicación||Concesión|
|Número de solicitud||US 11/762,773|
|Fecha de publicación||15 Mar 2011|
|Fecha de presentación||14 Jun 2007|
|Fecha de prioridad||24 Feb 1998|
|También publicado como||US6949106, US7169141, US7371210, US7867241, US7918861, US7931586, US8114097, US20020087049, US20020128633, US20030050649, US20070250073, US20070250074, US20070255291, US20070260115, US20080119871|
|Número de publicación||11762773, 762773, US 7905828 B2, US 7905828B2, US-B2-7905828, US7905828 B2, US7905828B2|
|Inventores||David L. Brock, Woojin Lee, Gary Rogers, Barry Weitzner|
|Cesionario original||Hansen Medical, Inc.|
|Exportar cita||BiBTeX, EndNote, RefMan|
|Citas de patentes (189), Otras citas (2), Citada por (32), Clasificaciones (59), Eventos legales (1)|
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet|
This application is a continuation of U.S. application Ser. No. 10/012,586, filed Nov. 16, 2001, now U.S. Pat. No. 7,371,210, which is a continuation-in-part of U.S. application Ser. No. 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112), which is a continuation of U.S. application Ser. No. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485), which is a divisional of U.S. application Ser. No. 09/375,666 (now U.S. Pat. No. 6,197,017), filed Aug. 17, 1999, which is a continuation of U.S. application Ser. No. 09/028,550, filed Feb. 24, 1998 (now abandoned). This application is also a continuation-in-part of U.S. application Ser. No. 09/783,637, filed Feb. 14, 2001 (now abandoned), which is a continuation of PCT/US00/12553, filed May 9, 2000, which claims the benefit of priority of U.S. Application Ser. No. 60/133,407, filed May 10, 1999. This application is also a continuation-in-part of PCT/US01/11376, filed Apr. 6, 2001, which claims priority the benefit of priority of U.S. application Ser. No. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485), and Ser. No. 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112). This application is also a continuation-in-part of U.S. application Ser. No. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485), and Ser. No. 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112). This application is also a continuation-in-part of U.S. application Ser. No. 09/827,643, filed Apr. 6, 2001 (now U.S. Pat. No. 6,554,844), which claims the benefit of priority to U.S. Application Ser. Nos. 60/257,869, filed Dec. 21, 2000, and 60/195,264, filed Apr. 7, 2000, and is also a continuation-in-part of PCT/US00/12553, filed May 9, 2000, from which U.S. application Ser. No. 09/783,637, filed Feb. 14, 2001, claims priority.
This application also claims the benefit of priority of U.S. Application Ser. Nos. 60/293,346, filed May 24, 2001, 60/279,087, filed Mar. 27, 2001, 60/313,496, filed Aug. 21, 2001, 60/313,497, filed Aug. 21, 2001, 60/313,495, filed Aug. 21, 2001, 60/269,203, filed Feb. 15, 2001, 60/269,200, filed Feb. 15, 2001, 60/276,151, filed Mar. 15, 2001, 60/276,217, filed Mar. 15, 2001, 60/276,086, filed Mar. 15, 2001, 60/276,152, filed Mar. 15, 2001, 60/257,816, filed Dec. 21, 2000, 60/257,868, filed Dec. 21, 2000, 60/257,867, filed Dec. 21, 2000, 60/257,869, filed Dec. 21, 2000.
This application is also related to application Ser. Nos. 11/762,768, 11/762,770, and 11/762,772, which were all filed on Jun. 13, 2007, and to application Ser. No. 11/762,774 (now U.S. Pat. No. 7,713,790) and Ser. No. 11/762,777, which were filed on the same date herewith.
The disclosures of the foregoing applications are expressly incorporated herein by reference. This application further expressly incorporates herein by reference, U.S. application Ser. No. 10/014,145 (now U.S. Pat. No. 6,775,582), Ser. No. 10/012,845 (now U.S. Pat. No. 7,169,141), Ser. No. 10/008,964 (now abandoned), Ser. No. 10/013/046 (now abandoned), Ser. No. 10/011,450 (now abandoned), Ser. No. 10/008,457 (now U.S. Pat. No. 6,949,106), Ser. No. 10/008,871 (now U.S. Pat. No. 6,843,793), Ser. No. 10/023,024 (now abandoned), Ser. No. 10/011,371 (now U.S. Pat. No. 7,090,683), Ser. No. 10/011,449 (now abandoned), Ser. No. 10/010,150 (now U.S. Pat. No. 7,214,230), Ser. No. 10/022,038 (now abandoned), Ser. No. 10/012,586, all filed on Nov. 16, 2001.
The present invention relates in general to a remote controlled flexible instrument comprising a flexible shaft, for introduction into a body cavity or body vessel to perform a medical procedure.
Catheters are used extensively in the medical field in various types of procedures, including invasive procedures. Minimally invasive surgery involves operating through small incisions, through which instruments are inserted. These incisions are typically 5 mm to 10 mm in length. Minimally invasive surgery is typically less traumatic than conventional surgery, due, in part, to the significant reduction in incision size. Furthermore, hospitalization is reduced and recovery periods shortened as compared with conventional surgery techniques. Catheters may be tailored to a particular size or form, depending on the incision and the size of the body cavity or lumen.
Due to the small size of the incision, the bulk of the surgery is not visible. Although the surgeon can have visual feedback from the surgical site via a video camera or endoscope inserted into the patient, or via radiological imaging or ultrasonic scanning, the ability to control the relatively simple laparoscopic instruments remains difficult. Even with good visual feedback, the surgeon's tactile and positional senses are physically removed from the operative site, rendering endoscopic procedures slow and clumsy.
Current instrumentation, with forceps, scissors, etc., inserted into the body at the end of long slender push rods is not fully satisfactory. The use of such conventional instrumentation increases operative time, and potentially heightens risk. For example, tissue may be injured when the laparoscopic tool moves outside the visual field. Moreover, there are limitations on the type and complexity of procedures that may be performed laparoscopically due, in part, to the limitations on the instruments that are used.
Development work has been undertaken to investigate the use of robotic work in surgery. Typically, these robotic systems use arms that reach over the surgical table and manipulate surgical instruments. The known robotic systems are large, clumsy to operate and relatively expensive to manufacture. The presence of a robot at the surgical site is problematic particularly when the robot is large and may impede access to the patient during surgery.
In accordance with a first aspect of the present inventions, a medical instrument assembly is provided. The medical instrument assembly comprises an intravascular catheter having an elongated flexible shaft, and a drivable mechanism to which the flexible catheter shaft is mounted. The drivable mechanism has an actuating element configured for effecting movement of the catheter within at least one degree-of-freedom. The medical instrument assembly further comprises a receiver to which the drivable mechanism is configured for being removably mated. The receiver is configured for operably coupling a drive unit to the actuating element. In an optional embodiment, the medical instrument assembly further comprises another intravascular catheter (e.g., in a coaxial arrangement with the intravascular catheter) having another elongated flexible shaft, wherein the other catheter shaft is mounted to the drivable mechanism, the drivable mechanism has another actuating element configured for effecting movement of the other catheter within at least one degree-of-freedom, and the receiver is configured for operably coupling a drive unit to the other actuating element. The medical instrument assembly may further comprise a carriage on which the mated drivable mechanism and receiver are slidably disposed.
The degree(s)-of-freedom to which intravascular catheter is moved can be varied. For example, the degree(s)-of-freedom may comprise an axial rotation of the flexible catheter shaft. In this case, the actuating element may comprise a first gear that encircles and effects the axial rotation of the flexible catheter shaft. The degree(s)-of-freedom may comprise a deflection of the flexible catheter shaft. In this case, the medical instrument assembly may further comprise a cable extending within the outer probe shaft or inner probe shaft, and the actuating element may comprise a pulley that pulls the cable to effect the deflection of the flexible catheter shaft. The degree(s)-of-freedom may comprise an actuation of an end effector associated with the flexible catheter shaft. In this case, the medical instrument assembly may comprise a cable extending within the flexible catheter shaft, and the actuating element may comprise a pulley that pulls the cable to effect the actuation of the end effector.
In one embodiment, the receiver has a complementary actuating element that mechanically interfaces with the actuating element. For example, the actuating element may comprise a gear, in which case, the complementary actuating element may comprise a complementary gear that mechanically interfaces with the gear. As another example, the actuating element may comprise a pulley, and the complementary actuating element may comprise a complementary pulley that mechanically interfaces with the pulley. In this case, the pulley and complementary pulley may have matching patterns that interlock with each other. In another embodiment, the medical instrument assembly further comprises cabling extending from the receiver and configured for coupling the drive unit to the actuating element.
In accordance with a second aspect of the present inventions, a robotic medical system is provided. The robotic medical system comprises a medical instrument assembly having a flexible intravascular catheter, a drivable mechanism to which the catheter is mounted, and a receiver to which the drivable mechanism is removably mated. The catheter drivable mechanism, and receiver may be the same as those described above. The robotic medical system further comprises a user interface configured for generating at least one command, a drive unit (e.g., one that has a motor array) coupled to the receiver, and an electric controller configured, in response to the command(s), for directing the drive unit to drive the actuating element via the receiver to effect movement of catheter within at least one degree-of-freedom (e.g., an axial rotation of the catheter, a deflection of the catheter, and/or an actuation of an end effector associated with the catheter).
In one embodiment, the electric controller is configured for directing the drive unit to drive the actuating element to effect movement of the catheter corresponding to a movement at the user interface. In another embodiment, the user interface is located remotely from the drive unit, the electrical controller is coupled to the drive unit via external cabling, and the drive unit is coupled to the receiver via external cabling. In still another embodiment, the robotic medical system further comprises a carriage on which the driver interface module is slidably disposed. If the medical instrument assembly has another intravascular catheter (e.g., in a coaxial arrangement with the intravascular catheter), the electric controller may further be configured, in response to the command(s), for directing the drive unit to drive the other actuating element via the receiver to effect movement of other catheter within at least one degree-of-freedom.
Numerous other objects, features and advantageous of the invention should now become apparent upon a reading of the following detailed description taken in conjunction with the accompanying drawings in which:
The present invention provides a system for remotely controlling a flexible instrument for use in medical applications, typically for operative or other medical procedures. The flexible instrument comprises a shaft or a tube of sufficient dimensions for passing through a small incision or natural body lumen or cavity and ultimately, for positioning a distal end of the shaft within the body at an internal target (operative) site. The flexible instrument can also support a tool at its distal end to allow more intricate medical procedures. A user or surgeon can control the position of the shaft from a master station, allowing operation from another part of the operating room, or even from another room or another building. In one aspect of the invention, the shaft can comprise one or more flexible segments, which a user can controllably bend, providing finer control in directing the shaft toward the target site. The control can result in, for example, a deflection or turning of the shaft, for guiding this shaft through or within various body cavities or lumens. The controllable bending is also useful for more precise positioning of a distal end of the flexible instrument at a desired operative site.
Preferably, the flexible instrument is used to perform minimally invasive procedures. “Minimally invasive procedure,” refers herein to a surgical procedure in which a surgeon operates through small cut or incision, the small incision being sufficiently necessary to access the operative site. In one embodiment, the incision length ranges from 1 mm to 20 mm in diameter, preferably from 5 mm to 10 mm in diameter. This procedure contrasts those procedures requiring a large cut to access the operative site. Thus, the flexible instrument is preferably used for insertion through such small incisions and/or through a natural body lumen or cavity, if necessary, so as to locate the catheter at an internal target site for a particular surgical or medical procedure. Examples of such minimally invasive procedures include intravascular procedures, such as the repair of a cardiac valve. The introduction of the flexible instrument into the anatomy may be by percutaneous or surgical access to a lumen or vessel, or by introduction through a natural orifice in the anatomy.
Surgeon's interface 11 is in electrical communication with computing system 12, which is, in turn, in electrical communication with drive unit 13. In one embodiment, drive unit 13 comprises a plurality of motors. The drive unit 13 is in mechanical communication with shaft 30 via conduit 23, which houses a plurality of mechanical cables driven by the plurality of motors in drive unit 13. In one embodiment, drive unit 13 is solely in mechanical communication with shaft 30. Because of the mechanical communication with shaft 30, the electromechanical components in drive unit 13 are disposed in an area remote from the operative site, and preferably in an area outside the sterile field. Preferably, objects that are difficult to sterilize, e.g. motors or electromechanical components, are kept at a sufficient distance from the patient to avoid contamination. This distance is readily ascertainable by doctors, nurses, and other appropriate medical professionals. In one embodiment, the sterile field has the rest surface of the operating table as its lower boundary. Thus, drive unit 13 is preferably located below the plane of the sterile field, i.e. below the rest surface of the operating table. The patient or subject may be further protected from drive unit 13 with a sterile barrier, such as a sterile cloth. With respect to the drive unit, such as drive unit 13 in
Accordingly, one aspect of the present invention provides a drive unit capable of remotely driving articulation of a flexible instrument, where the drive unit is remote from the subject and the flexible instrument. The slave station of the present invention employs, to a large part, a mechanical arrangement that is effected remotely and includes mechanical cables and flexible conduits coupling to a remote motor drive unit. This provides the advantage that the instrument is purely mechanical and does not need to be contained within a sterile barrier. The instrument may be autoclaved, gas sterilized or disposed in total or in part.
Cables in conduit 23 also mechanically drives the translation of receiver 24 along rails 25. The rails, and thus the linear translation extend at an acute angle with respect to the operating table, as well as the subject. This angular arrangement disposes the flexible instrument system in a convenient position over the patient. This arrangement also minimizes the number of components that operate within the sterile field, as drive unit 13 is maintained at a location remote from the sterile field.
In one embodiment, the interlocking mechanism can comprise a magnetic attachment, where a first series of magnets in the mechanically drivable mechanism interacts with a second series of magnets in the receiver. Each series of magnets can couple with the mechanical cables.
For the sake of simplicity,
Regarding the interface 11, computer system 12 and drive unit 13, reference is also made to co-pending application PCT Serial No. PCT/US00/12553 filed May 9, 2000, and U.S. Provisional Application Ser. No. 60/279,087 filed Mar. 27, 2001, both of which are incorporated by reference herein in their entirety.
A more detailed discussion of the master station, the slave station and computation system or controller 12 is provided below.
In one embodiment, input device E features handles that control the motion of the shaft and a tool. Referring back to
Reference may also be made to copending application Ser. No. 10/008,457, filed of even date herewith, which discloses other details of a master station input device (master positioner) that may be used in carrying out the control described herein.
Display F provides a direct video image of the site surrounding the distal end of the shaft. An endoscope supporting a camera is inserted into the body of a subject, providing the video feed of the operative site. The camera can be mounted on or housed at the distal end of the shaft. The camera can provide a view of the operative site, or may be positioned away from the site to provide additional perspective on the surgical operation.
Other detection systems may be used for providing different images useful in assisting the surgeon in performing the medical procedure. Thus, various signals may be utilized in conjunction with or in alternative to the video image, such as ultrasound (echocardiography, Doppler ultrasound), angiography, electrophysiology, radiology or magnet resonance imaging (MRI). Also, an audio signal could be used for guiding the shaft. These detection techniques can be operated with the flexible instrument of the present invention to enhance guidance of the shaft to the site as well as manipulation at the site.
In association with the input devices of
As discussed previously,
The block diagram of
Communication cables 708 intercouple interface board 704 to eight separate module boards 706. Interface board 704 can be a conventional interface board for coupling signals between digital bus 702 and individual module boards 706. Each module board 706 includes four motion control circuits 710, as illustrated in
The motor control system may be implemented in two ways. In the first method the user may utilize the four types of control modes provided by the motor control sub unit 706: positional control; proportional velocity control; trapezoidal profile control; and integral velocity control. The use of any one of these modes can involve simply specifying desired positions or velocities for each motor, and necessary control actions are computed by motion control IC 710 of the motor control sub unit, thereby greatly reducing the complexity of the control system software. However, in the case where none of the onboard control modes are appropriate for the application, the user may choose the second method in which the servo motor control software is implemented at the PC control station. Appropriate voltage signal outputs for each motor are computed by the PC control station and sent to the motor control/power amplifier unit (706, 712). Even if the computation load is mostly placed on the PC control station's CPU, the use of high performance computers as well as high speed PCI bus for data transfer can overcome this problem.
First, the joint sensors (box 435), which are optical encoders in the present embodiment, of the surgeon's interface system are read, and via forward kinematics (box 410) computation of the interface system, the current positions (see line 429) and orientations (see line 427) of the interface handle can be performed. The translational motion of the surgeon's hand motion is scaled (box 425) whereas the orientations are kept identical, resulting in desired positions (see line 432) and orientations (see line 434) of the catheter's tool. The results are then inputted into the inverse kinematics algorithms for the catheter's tool, and finally the necessary joint angles and insertion length of the catheter system are determined. The motor controller (box 420) then commands the corresponding motors to positions such that the desired joint angles and insertion length are achieved.
The slave station comprises a flexible instrument, e.g. a shaft optionally supporting a tool at its distal end, for insertion into a subject. In one embodiment, the flexible instrument is a catheter. “Catheter” as defined herein refers to a shaft adapted for, but not necessarily limited to, insertion into a subject, and more particularly for insertion into natural body lumens, canals, vessels, passageways, cavities or orifices. The shaft is typically tubular, but any elongate shaft may be adaptable for insertion into the subject. The shaft can be solid or hollow. A subject can be a human, an animal, or even individual organs or tissues that are dead or living.
The introduction of the flexible instrument into the human or animal body, may be by percutaneous or surgical access to a lumen or vessel, or by introduction through a natural orifice in the body. In this regard, examples of natural lumens include body vessels such as a blood vessel (artery, chamber of the heart or vein), urinary system vessels (renal collection ducts, calix, ureter, bladder or urethra), hepatobilliary vessels (hepatic and pancreatic ducts, chyle ducts; common or cystic duct), gastrointestinal tract (esophagus, stomach, small and large intestine, cecum and rectum), gynecological tract (cervix, uterus, fallopian tube or milk ducts and mammary canals of breast), nasopharynx (eustacean tube, sinuses, pharynx, larynx, trachea, bronchus, bronchiole, tear duct) seminal vesicle, spinal canal, or ventricles of the brain. Examples of a natural orifice include oral, rectal, nasal, otic, optic, or urethral orifices.
The shaft can be constructed from a standard 9 French (2.67 mm diameter) coronary guiding catheter.
The shaft may support various forms of tools, typically at its distal end. As depicted in
Exemplary objects implanted in a subject include staples, tacks, anchors, screws, stents, sutures, and a variety of other objects implanted by physicians and medical professionals.
The procedure of delivering (procedure 7, above) can further include delivery of agents including, but not limited to: 1. Adhesives. 2. Cryonics. 3. Drugs. 4. Biologic agents. 5. Radioactive elements. 6. Bulking agents.
Furthermore, the flexible instrument can be used as a sensor. Parameters that may be sensed include, but are not limited to: 1. Force. 2. Pressure. 3. Electrophysiological signals. 4. Chemical, oxygen, Ph, blood gas. 5. Temperature. 6. Vibration.
The slave station also comprises a drive unit capable of articulating the flexible instrument, particularly the shaft and the tool. The drive unit is to drivably coupled to a receiver for receiving the mechanically drivable mechanism. In one embodiment, this coupling occurs via cables. The drive unit is electronically controllable from the master station, as there is an electronic link between the drive unit and a user input device of the master station.
When the receiver receives the mechanically drivable mechanism, the drive unit then has a direct pathway for controlling operation of the shaft and tool. If the shaft has a controlled flexible segment, the drive unit is capable of activating or bending the flexible segment via the mechanically drivable mechanism, for actuation of the shaft, the tool and positioning of the tool at an operative site within the subject. In one embodiment, drive unit is capable of bending the flexible segment via a first set of cables which couple the drive unit to the receiver, and a second set of cables which drivably couple the mechanically drivable mechanism to the flexible segment and the tool.
One aspect of the present invention provides a remote controlled outer (guide) catheter having a distal end disposed at or in an area about an operative site, preferably in the immediate area of an operative site. A coaxial inner (working) catheter nested within the outer catheter can then be used to perform the surgical or medical procedure. Previous surgical procedures involve insertion of a trocar or cannula into the subject at a relatively short depth to provide an opening for receipt of the catheter, which is then guided to the operative site. Typically the catheter is not disposed at the immediate area around the operative or target site. Thus, if the surgeon needs a second catheter, the first catheter must be withdrawn and the second catheter is guided to the target site. Such repeated insertions can aggravate trauma experienced by the patient.
The feature of the present invention, on the other hand, employs an outer catheter disposed at the target site, which allows more than one shaft to be inserted and withdrawn with minimal irritation or trauma experienced at the passageway leading to the operative site. In one embodiment, the outer catheter housing a coaxial inner catheter is disposed at the target site. The inner catheter can immediately function at the operative site. If a second inner catheter is required, the first inner catheter can be quickly withdrawn through the outer guide catheter and the second inner catheter inserted through the outer catheter with minimal injury to the subject.
A feature of this aspect of the present invention allows coaxial multiple shafts to be remote controlled independently of each other.
The rotation of outer shaft 32 and inner shaft 34 about the co-axis can be controlled independently. Control element 60, or gear 60 in interface 26 encircles outer shaft 30 and controls the rotational position of guide shaft 32 in the direction indicated by rotational arrow 65. Gear 68 in interface 26 encircles inner shaft 34. Control element 68 controls the rotational position of the inner shaft 34 in the direction indicated by rotational arrow 69. Rotational arrows 65 and 69 indicate rotation about the “shaft lumen axis”, i.e. the axis tangential to the cross section of the shaft lumen.
If a tool were supported at the distal end of inner shaft 34, control element 68 would control the rotational position of the tool about the shaft lumen axis as well. If the distal end were flexed, the shaft would curve and rotation of the shaft would cause the tool to trace a circle, and not cause the tool to rotate about its internal axis. As described below, another control can be positioned in the mechanically drivable interface for solely controlling the tool independent of the shaft controls.
Another aspect of the present invention provides a remote controlled flexible instrument capable of controlled bending, as controlled by a user at a master station. A flexible instrument comprises a shaft having at least one section that is flexible. “Flexible” refers herein to a material that is inherently and sufficiently deformable to readily pass atraumatically through a natural body lumen, cavity, vessel, orifice and the like. In one embodiment, the shaft is sufficiently flexible to readily flex and/or conform to a pathway in an anatomic vessel, lumen, cavity or the like. Non-flexible or rigid catheters can be distinguished from flexible instruments by the following test. By knowing the dimensions of a rigid catheter and the point of entry into the subject, one can calculate the position of the catheter end point inside the subject. In contrast, even if the dimensions and point of entry of a flexible shaft were known, the position of its end point within the subject cannot be calculated with precision because the flexible shaft may bend.
Flexible instruments of the present invention can also be distinguished from other known catheters that mimic bending motions solely through a series of rigid sections linked by joints. Thus, a “bend” is not the result of a deformation of the catheter material but by the pivoting or rotation of two rigid sections about a joint. In contrast, flexible instruments of the present invention include at least one flexible segment that is bendable without requiring the use of joints. The bending is remotely controlled, allowing deflection at these flexible segments away from the lumen axis of the segment. Bending in this sense is possible by choice of inherent flexibility of the instrument coupled with an induced deflection at the flexible segment. Inherent flexibility can be achieved by choice of a deformable material, such as. Inherent flexibility can also be achieved by designed construction using a more rigid material, for example carving out segments of the material, i.e. slotting the material, such that the material is sufficiently thin for bending. Of course, the flexible instrument can comprise rotatable or pivotable joints, but the flexible capability is not the result of employing such joints, but by the deformability of the shaft material. In one embodiment, the bending is remotely controlled via a drive unit drivably coupled to the receiver for receiving a mechanically drivable mechanism or shaft mount. The shaft mount is then drivably coupled to the controlled flexible segment, thereby providing a drivable bending mechanism.
Those of ordinary skill in the art can appreciate that the shaft can be tailored for a particular body lumen. Factors of the shaft construction include resiliency of the walls of the lumen, curvature of the passageway, location of the target site, diameter of the lumen, etc. For example, a shaft for passing through a colon can be, but is not necessarily, manufactured from a material that is less deformable than a shaft for passing through a small, delicate blood vessel. Lumens that present passageways of high curvature may also require a more easily deformable, and thus more flexible, shaft than does a relatively straight lumen. Deformability of the shaft can also be tailored by varying the dimensions, particularly the diameter, of the shaft.
In this aspect of the invention, a user can controllably bend or flex at least a section of the flexible instrument. In one embodiment, this controlled bend can be provided by a shaft having at least one flexible segment, alternatively a controlled flexible segment. By manipulating controls at the master station, a user can induce a bend in the shaft at the flexible segment. Preferably, the bend at the flexible segment is actuated mechanically, thus distinguishing this aspect of the present invention from prior art catheters where the bends are induced electrically. For example, U.S. Pat. No. 5,238,005 describes a bending mechanism caused by varying the electrical resistance through a catheter material having a negative coefficient. Heating one area of a catheter by increasing its electrical resistance results in contraction of that area, causing the catheter to deflect toward the contracted area. In contrast, the present catheter responds to mechanical forces.
Alternatively, flexible segment 42 may be in the form of a metal coil of diameter similar to the diameter of outer shaft sections 36 and 38.
Referring to both
More than one flex wire can be spaced about the circumference of outer shaft 32 to allow bending along multiple directions different from arrow 55 yet orthogonal to shaft 30. For example,
If inner shaft 34 supports a tool at its distal end, the bending motions, along with the rotation about the co-axis, serves to place the tool at any place in three-dimensional space. Another control element, i.e. pulley 72 controls cable 28, which extends through the hollow area of inner shaft 34, thereby allowing control of a specific tool operation. Depending on the complexity of the device, one or more cables leading to the tool may be required. In one embodiment,
In one embodiment, the system comprising the flexible instrument comprises tool or mini-tool (18), the operative segment (42), the catheter stem (32, 34), the coupler (24, 26) comprising the mechanically drivable mechanism 26 and the receiver 24, the drive unit (13), the controller (12) and the surgeon's interface (11). The coupler provides a translational degree-of-freedom achieved by using a sliding mechanism, i.e. rails 25, onto which the coupler is mounted, as illustrated in
The following describes the mathematical mapping of the physician's command input to the motion of the catheter system.
Flexible instrument system 500 comprises flexible instrument 510 having a shaft 528 extending to mechanically drivable mechanism 526, which interlocks with base (or receiver) 506. Base 506 is supported on carriage 508. Carriage 508 in turn is adapted for linear translation and supported by elongated rails 512 and 514. Rails 512 and 514 terminate at one end via end piece 516, which provides further support. Support base 504 terminates rails 512 and 514 at their other end. Carriage 508 includes bearings or bushings 509 that support the carriage from rails 512 and 514.
Flexible instrument system 500 employs two separate cable bundles for mechanically driving the flexible instrument along rails 512 and 514. Pulley 521 (dotted outline), residing within carriage control module 520, receives a first pair of cables 518. Pulley 521 also receives a second set of cable (see cabling sections 513 and 515 of corresponding
One pair of cables travels through shaft 528 and through appropriate holes in the base 600, wrapping around a curved surface of the link 601 and then attaching to the link. Tension on this pair of cables rotates the link 601 along with the upper and lower grips or jaws 602 and 603 about axis 532.
Two other pairs of cables also extend through the shaft 528 and through holes in the base and then pass between fixed posts 612. These posts constrain the cables to pass substantially through axis 532, which defines rotation of link 601. This construction essentially allows free rotation of link 601 with minimal length changes in the cables passing to jaws 602 and 603. Thus, the cables actuating jaws 602 and 603 are essentially decoupled from the motion of link 601 and are not effected by any rotation of link 601. Cables controlling jaw movement terminate on jaws 602 and 603. These cables permit independent operation of the jaws 602 and 603 in respective clockwise and counter clockwise directions with respect to axis 536. A similar set of cables is present on the under-side of the link 601 (not shown). Each of the jaws 602 and 603, as well as the link 601, may be constructed of metal. Alternatively, link 601 may be constructed of a hard plastic material. Base 600 may also be constructed of a plastic material and may be integral with shaft 528.
Bending of flexible segment 530 is provided via diametrically disposed slots 662, which define spaced ribs 664. Flexible segment 530 also has a longitudinally extending wall 665 through which cabling may extend, particularly for the operation of the tool. One of the pairs of cables of bundle 538 controlling flexible segment 530 terminates where base 600 intercouples with shaft 528. This pair of cables works in concert to cause bending as indicated by arrow J3, i.e. in a direction orthogonal to the pivoting provided at wrist axis 532. In
Receiver 506 and drivable mechanism 526 each comprise enclosed housings supporting a plurality of control elements, such as intercouplable drivewheels and associated pulleys or cams. Inter-engaging gears 540 and 542 are supported respectively in the modules 506 and 526. A pair of cables from bundle 524 engages pulley 544 (see
Drivable mechanism 526 interlocks with receiver 506, providing the mechanical connection that allows the drive unit to run cabling in flexible instrument 510. Blades 606, jutting out from the housing of receiver 506, engage with corresponding slots 608 associated with drivable mechanism 526. Projecting from the proximal end of receiver 506 is ridge 610, which is substantially U-shaped and provides another interlocking feature for mating with a similarly shaped slot 614 at the same end of drivable mechanism 526. Posts 616 protruding from the housing of receiver 506 are adapted to releasably mate with holes 618 in drivable mechanism 526. Posts 616 and holes 618 to interlock with each other, but may be released from each other via side-disposed buttons 620, as illustrated in
Each of cams 626 has an off-center axis 631. As viewed in
As described to this point, the bending or deflection of the shaft can be actuated by mechanical means such as a wire extending along a length of the shaft. Thus, actions at the distal end of shafts may be controlled by mechanical elements, such as cables, wires or other tendons.
Alternatively, actuation of the controlled bending can occur by other means, such as by remote electromagnetic signal couplings.
The flexible instrument depicted in
In the illustration of
It is understood that non-operative segments of the catheter in
Another aspect of the present invention provides a remote controlled flexible instrument operable within the sterile field, and disposable after use. The sterility of reusable medical instruments and implements are maintained by well-known methods such as exposure to sterile solutions and/or autoclaving. For some medical implements, it can be more cost effective to manufacture them from low cost materials and dispose them after a single use, or use on a single patient. But for certain other medical instruments, its manufacture from low cost materials still results in a costly product due to the intricate nature of the individual parts and the labor required to manufacture complex components.
It is another feature of the present invention to provide a design for a remote controlled flexible instrument having disposable components, particularly those components that are exposed to the sterile field. The present design allows the use of injection-molded plastic parts. The disposable component can be easily and quickly engaged into and disengaged from a non-disposable, reusable base. The components can be locked onto the base by snapping or interlocking matched parts, without having to thread cable wires or attach any intricate components.
One aspect of the present invention provides a disposable implement comprising a disposable mechanically drivable mechanism, a disposable shaft extending from the drivable mechanism, and optionally a disposable tool supported on a distal end of the shaft. Referring back to
Another design for a disposable implement is illustrated in
Disposable implement 510 may be considered as comprising a disposable, mechanically drivable mechanism such as the coupler or module 526 interconnected to a tool 534 through an elongated disposable flexible shaft or stem 528. This disposable and flexible implement is mounted so that the mechanically drivable mechanism may be connectable to and drivable from a drive mechanism, such as illustrated in
The disposable implement is purely mechanical and can be constructed relatively inexpensively thus lending itself readily to being disposable. It may be difficult to make only the tool disposable, due to the intricate nature of the tool parts, which may require the user to perform intricate maneuvers and cable threading into the base of the slave station. Here, the disposable implement, i.e. the tool, shaft and drivable mechanism are manufactured as a single piece disposable unit, thus eliminating the need for intricate instrument or tool exchange procedures.
Ideally, the base of the slave station, which contacts the disposable implement, is easily cleanable. It is preferred that the disposable implement, which operates within the sterile field, experiences minimal contamination by contacting the slave station. In one embodiment of the present invention, as illustrated in
One advantage of the present invention is the ease of engaging and disengaging the disposable implement. In a particular medical procedure, a multitude of instrument exchanges may be required, and the system of the present invention is readily adapted for quick and easy instrument exchange. Because the receiver is maintained in a fixed position, the surgeon can easily exchange instruments by readily decoupling at the modules 506 and 526. The ease of exchanging instruments lends to the portability of the slave station. This portable nature of the slave unit comes about by virtue of providing a relatively simple flexible instrument in combination with an adaptor (module 506, module 520, carriage 508 and associated components) for supporting the flexible instrument. Overall, the slave station is of a relatively small configuration. Because the slave unit is purely mechanical, and is decouplable from the drive unit, the operator can readily position the slave unit. Once in position, the slave unit is then secured to the support, and the mechanical cabling of the slave unit is then attachable to the drive unit. This makes the slave unit both portable and easy to position in place for use.
Another aspect of the present invention provides a system for repairing a cardiac valve, such as a mitral valve. Current mitral valve repair techniques, either open or minimal access, require the surgeon to place the patient on cardiopulmonary bypass and stop the heart. The left atrium is then opened and exsanguinated to allow the surgeon to perform the repair. This aspect of the present invention provides a minimally invasive mitral valve annuloplasty technique featuring the following advantages: (1) peripheral venous access; (2) the heart can continue to beat during the repair; and (3) assessment of the correction of valve incompetence in real-time using, for example, Doppler ultrasound guidance.
In one embodiment, the present cardiac valve repair system employs a guide shaft extending from a site outside a patient to an area about the cardiac valve. The guide shaft receives a flexible inner shaft for disposing a tool at the area about the cardiac valve, where the tool is supported at the distal end of the guide shaft. Preferably, the inner shaft has a relatively small diameter enabling percutaneous intravascular and endoscopic surgery. Even more preferably, the inner shaft, and optionally the guide shaft, is capable of accessing the mitral valve from the peripheral circulation, eliminating the need for incisions through the chest wall. In one embodiment, the inner shaft can have a diameter ranging from 8 to 15 French (2.5-5.0 mm). The outer catheter may be constructed from a standard 9 French coronary guide catheter, having a diameter of 2.67 mm and a wall thickness of 0.1 mm. In other embodiments, the inner catheter can have an outer diameter of 1.1 mm and an inner diameter of 0.09 mm. In yet another embodiment, the braided stainless steel cables are 0.63 mm in diameter and are capable of transmitting 178 Newtons (40 lbs. approx.).
A feature of this aspect of the present invention is that the percutaneous access to the mitral valve can be accomplished on a beating heart, eliminating the risks associated with cardiopulmonary bypass (CPB). To enable a procedure on the beating heart, preferably the procedure can be performed under physiologic conditions. The physician may monitor the procedure by, for example, transesophageal echocardiography, instead of a video image. This technique enables real-time assessment of the correction of the mitral valve regurgitation (MR) during the procedure, further enabling intra-operative provocative cardiac testing, with preload and afterload challenges and cardiac pacing all under trans-esophageal echo and trans-thoracic ultrasound guidance to optimize repair.
The tool can be remote controlled, as described herein, and can be designed for use in any procedure of the cardiac valve repair process. For example, a first set of tools is capable of percutaneous mitral valve annuloplasty. This represents a paradigm shift in management of disease from MIS and open surgical to intraluminal interventions. While this catheter-based intervention is described in connection with mitral annuloplasty, the technique can also be applied to other structures such as, by way of example and not limiting, the billiary tree, the genitourinary tract and intraventricular neurosurgery.
The system further includes a retainer at the area of the cardiac valve, where the retainer is attached to an annulus of the cardiac valve. As will be described in greater detail below, the retainer is closeable via the tool to draw the annulus into a smaller diameter.
In one embodiment, a trans-septal guide catheter is used to guide and support an inner catheter. The guide catheter is introduced by percutaneous access, and allows the clinician to access the left atrium via the venous circulation, i.e. through the heart wall (see
Once access to the left atrium is established, the inner catheter is threaded into the left atrium through the guide catheter. The inner catheter contains attachment anchors for deployment at desired points around the mitral valve annulus. A remote controlled 5-degree-of-freedom tool and wrist can be utilized to precisely reach the annulus. Ultrasound may be used to visualize the system and guide the anchor positioning and placement. This ultrasound may be trans-esophageal ultrasound or trans-thoracic ultrasound, for example. Furthermore, electrophysiologic signals of the heart may be used to aid in precisely locating the position of the tool at the fibrous mitral valve annulus.
There is now described a number of techniques employing the catheter apparatus of the present invention. These techniques are described herein primarily in connection with mitral valve repair.
In one embodiment, threading or sewing a ring about the annulus reduces the annulus diameter, where the ring is closeable. The annulus comprises relatively tough tissue just above the top of leaflets. As viewed in
To carry out the technique of the present invention, a guide catheter 230 is employed, such as a transseptal atrial guide catheter. The access for catheter 230 is via the vena cava to the right atrium 221. This access may be from above via the jugular vein or below by way of the femoral vein. A puncture is made in the wall 238 of the right atrium into the left atrium 220, allowing distal end 232 of catheter 230 to pass into the left atrium 220.
Once the straightened wire 100 has passed through the catheter, it assumes the position shown in
As an alternate to the use of a balloon 234, a malecot 236 may be used. This is a mechanical device with expandable wings, as illustrated in
After guide catheter 230 is in place with the balloon 234 inflated to secure it in position, flexible catheter 240 is threaded through guide catheter 230 to a position just about the mitral valve, as illustrated in
After a single threading or sewing has occurred, such as in
Initially, once the threading through the base of the valve ring is completed, the outer tube 254 engages securing piece 256 moving it downwardly in the view of
Once the securing piece and the retaining button are firmly held to the wire 212, then the member 250 may be withdrawn through the guide catheter 230. The flexible catheter member 240 may then be reinserted with a different tool such as a pair of scissors for cutting the exposed end of the fiber 212.
Another possible technique for reducing the annular diameter involves a loop of cable that extends through hooks or anchors placed in the annulus, as illustrated in
In one embodiment, the flexible instrument comprises a guide catheter 150, as illustrated in the diagram of
Guide catheter 150 may be approximately 8 French in diameter with a computer controlled flexible end portion, illustrated in
A tensioning cable, such as the cable or wire 162 illustrated in
After the crimping or securing step, then the cable crimper is removed and the cutting catheter 182 is introduced as also illustrated in
As indicated previously, the proximal end of the catheter is comprised of a disposable coupling mechanism that engages a drive mechanism, such as is shown in
In one embodiment, a drive unit is coupled with the inner shaft and the guide shaft independently, the drive unit capable of independently effecting movement of each shaft to at least one degree of freedom.
For each coupler element, rotary disks transmit motion from the remotely controlled drive system to the catheter articulations. By way of example, in a first coupler element, a horizontal disk may drive the distal flexure. Another element may include disks, which control the axial and/or rotary positions of the inner catheter and, for example, the advance of the anchors. All of the coupling elements are mounted on a slider or sliders, which allows independent control of the linear advance of the outer and inner catheters. Again, refer to
In accordance with the technique, such as described in
Another feature of the present invention provides a system for closing the base of a cardiac valve, such as a mitral valve. The closing can occur primarily by a stapling technique in which staples are attached to the valve ring or annulus to draw the annulus into a smaller diameter. In this way the leaflets are then more appropriately positioned for opening and closing.
Balloon 334 may be supported at distal end 332 of guide catheter 330. Once guide catheter 330 is positioned at a desired location, balloon 334 is inflated to secure guide catheter 330 to the wall with end 332 extending into the left atrium. Once balloon 334 is inflated, it can be snugged back against the septal wall between left atrium 220 and right atrium 221. The inner diameter of the catheter 330 may be on the order of approximately 5 mm in diameter. As an alternative to balloon 334, a malecot may be used, i.e. a mechanical device having expandable wings capable of securing catheter 330 against septal wall 238.
Guide catheter 330 coaxially nests flexible catheter 340 and its associated staple delivery system 342. With regard to this catheter construction, reference is made to a co-pending provisional application, Ser. No. 60/269,200 filed Feb. 15, 2001, as well as pending application PCT serial number PCT/US00/12553, filed Nov. 16, 2000, both of which are incorporated by reference herein in their entirety.
After balloon 334 is inflated to secure guide catheter 330 in position, flexible inner catheter 340 is threaded through guide catheter 330 to a position just above mitral valve 210, as illustrated in
Flexible catheter 340 is manipulated to cause a stapling about annulus 211 of mitral valve 210. The releasing of each staple is controlled by a mechanism preferably within flexible catheter 340 and operable from a user interface station remote from the subject. Once all of the stapling has occurred, wire 312 is pulled in the direction of arrow 361 in
A plurality of staples 350 having loops 353 encircling fiber 312, secures fiber 312 to the annulus of the mitral valve, terminating at points 345 and 356. The procedure of looping fiber 312 and stapling can be performed via remote control from a master station under surgeon control with multiple degrees-of-freedom of the tool so as to accurately locate the implant fiber 312 and staples 350.
Fiber 312 is fixedly secured to end staple 350 at point 345. The remaining staples are free to glide along fiber 312. When all the staples are secured about the annulus, fiber 312 may be cinched down under ultrasonic guidance, watching for a reduction or elimination of the valve regurgitation. Once adequate tension has been placed on the cable 312, tension can be maintained without disengaging the closure system. This allows the clinician to monitor the patient for some period of time to confirm that the repair has taken place. Once the clinician is satisfied with the repair, the cable can be locked off with a crimp or by some other technique and the cable may then be cut.
Another feature of the present invention is that the technique can be performed under physiologic conditions. The physician can monitor the procedure by, for example, transesophageal echocardiography, instead of a video image. The aforementioned “lasso” technique enables real-time assessment of the correction of the mitral valve regurgitation (MR) as the “lasso” is tightened. This enables performance of intra-operative provocative cardiac testing, with preload and afterload challenges and cardiac pacing all under trans-esophageal echo and trans-thoracic ultrasound guidance to optimize repair.
An alternate embodiment of a staple is illustrated in
Once the catheter and balloon are in place, such as illustrated in
After the anchors are seated, as illustrated in
Several different techniques may be used for guiding the catheter 402. For example, transesophageal ultrasound or transthorasic ultrasound may be employed. Also, radiopaque dye fluoroscopy or electrophysiologic techniques may be employed for positioning of the catheter.
The tether can be placed about the mitral valve and tightened by using coaxial inner and outer catheters. The concepts illustrated in
The aforementioned techniques for guiding the catheter may also be used for monitoring the effectiveness of the technique of the present invention. By monitoring the positioning of the balloon, one can assure that the ends of the tether are preferably at the trigone area. Also, as the tether is tightened, the surgeon may monitor the mitral valve activity to determine whether the valve base ring has closed properly so as to reduce or eliminate valve regurgitation. Tether ends may be secured by knotting the ends thereof so as to hold the tether in a closed position.
The techniques described herein may also be applied in other medical procedures involving repair of other anatomic body members. For example, the techniques described in
The present invention provides a relatively simple system, both in the construction and in its use. The capability to decouple components at the drive unit and the receiver results in a readily portable and readily manually insertable flexible instrument system that can be handled quite effectively by the surgeon or assistant when it is to be engaged with the patient. Only a minimal number of components are positioned within the sterile field, enabling facile manipulation about the surgical site. An advantage of the system of the present invention is the decoupling nature of the system. In the system of the present invention, the instrument, drive unit and controller are inherently decoupled (attachable and detachable). The decouplable design enables the slave station to be readily portable. The instrument can be maintained as sterile but the drive unit need not be sterilized.
The instrument of the present invention is relatively small because the actuators are not housed in any articulating structure in the system of this invention. Because the actuators are remote, they may be placed under the operating table or in another convenient location and out of the sterile field. Because the drive unit is fixed and stationary, the motors may be arbitrary in size and configuration. Finally, the design allows multiple, specialized instruments to be coupled to the drive unit, allowing a user to design the instrument for particular surgical disciplines.
Having now described a limited number of embodiments of the present invention, it should now be apparent to those skilled in the art that numerous other embodiments and modifications thereof are contemplated as falling within the scope of the present invention.
|Patente citada||Fecha de presentación||Fecha de publicación||Solicitante||Título|
|US3414137||6 Jun 1966||3 Dic 1968||Commissariat Energie Atomique||Remote handling device|
|US4604016||3 Ago 1983||5 Ago 1986||Joyce Stephen A||Multi-dimensional force-torque hand controller having force feedback|
|US4654024||4 Sep 1985||31 Mar 1987||C.R. Bard, Inc.||Thermorecanalization catheter and method for use|
|US4750475||1 Ago 1986||14 Jun 1988||Kabushiki Kaisha Machida Seisakusho||Operating instrument guide mechanism for endoscope apparatus|
|US4853874||20 Nov 1987||1 Ago 1989||Hitachi, Ltd.||Master-slave manipulators with scaling|
|US4941454||5 Oct 1989||17 Jul 1990||Welch Allyn, Inc.||Servo actuated steering mechanism for borescope or endoscope|
|US4977886||27 Oct 1989||18 Dic 1990||Olympus Optical Co., Ltd.||Position controlling apparatus|
|US4979949||26 Abr 1988||25 Dic 1990||The Board Of Regents Of The University Of Washington||Robot-aided system for surgery|
|US5052402||24 Ene 1991||1 Oct 1991||C.R. Bard, Inc.||Disposable biopsy forceps|
|US5072361||1 Feb 1990||10 Dic 1991||Sarcos Group||Force-reflective teleoperation control system|
|US5078140||23 Sep 1986||7 Ene 1992||Kwoh Yik S||Imaging device - aided robotic stereotaxis system|
|US5084054||5 Mar 1990||28 Ene 1992||C.R. Bard, Inc.||Surgical gripping instrument|
|US5086401||11 May 1990||4 Feb 1992||International Business Machines Corporation||Image-directed robotic system for precise robotic surgery including redundant consistency checking|
|US5116180||3 May 1990||26 May 1992||Spar Aerospace Limited||Human-in-the-loop machine control loop|
|US5154717||31 Oct 1990||13 Oct 1992||The Board Of Regents Of The University Of Washington||Robot-aided system for surgery|
|US5172700||17 Sep 1990||22 Dic 1992||C. R. Bard, Inc.||Disposable biopsy forceps|
|US5184601||5 Ago 1991||9 Feb 1993||Putman John M||Endoscope stabilizer|
|US5217003||18 Mar 1991||8 Jun 1993||Wilk Peter J||Automated surgical system and apparatus|
|US5236432||24 Ago 1992||17 Ago 1993||Board Of Regents Of The University Of Washington||Robot-aided system for surgery|
|US5238002||8 Jun 1992||24 Ago 1993||C. R. Bard, Inc.||Disposable biopsy forceps|
|US5238005||18 Nov 1991||24 Ago 1993||Intelliwire, Inc.||Steerable catheter guidewire|
|US5271381||18 Nov 1991||21 Dic 1993||Vision Sciences, Inc.||Vertebrae for a bending section of an endoscope|
|US5287861||30 Oct 1992||22 Feb 1994||Wilk Peter J||Coronary artery by-pass method and associated catheter|
|US5299288||18 Sep 1991||29 Mar 1994||International Business Machines Corporation||Image-directed robotic system for precise robotic surgery including redundant consistency checking|
|US5339799||17 Abr 1992||23 Ago 1994||Olympus Optical Co., Ltd.||Medical system for reproducing a state of contact of the treatment section in the operation unit|
|US5347987||4 May 1992||20 Sep 1994||Feldstein David A||Self-centering endoscope system|
|US5350355||14 Feb 1992||27 Sep 1994||Automated Medical Instruments, Inc.||Automated surgical instrument|
|US5368015||7 Jun 1993||29 Nov 1994||Wilk; Peter J.||Automated surgical system and apparatus|
|US5372147||16 Jun 1992||13 Dic 1994||Origin Medsystems, Inc.||Peritoneal distension robotic arm|
|US5382885||9 Ago 1993||17 Ene 1995||The University Of British Columbia||Motion scaling tele-operating system with force feedback suitable for microsurgery|
|US5389100||6 Nov 1991||14 Feb 1995||Imagyn Medical, Inc.||Controller for manipulation of instruments within a catheter|
|US5397323||30 Oct 1992||14 Mar 1995||International Business Machines Corporation||Remote center-of-motion robot for surgery|
|US5402801||28 Abr 1994||4 Abr 1995||International Business Machines Corporation||System and method for augmentation of surgery|
|US5409019||3 Nov 1993||25 Abr 1995||Wilk; Peter J.||Coronary artery by-pass method|
|US5410638||3 May 1993||25 Abr 1995||Northwestern University||System for positioning a medical instrument within a biotic structure using a micromanipulator|
|US5417210||27 May 1992||23 May 1995||International Business Machines Corporation||System and method for augmentation of endoscopic surgery|
|US5429144||5 Abr 1994||4 Jul 1995||Wilk; Peter J.||Coronary artery by-pass method|
|US5447149||25 Ago 1993||5 Sep 1995||Kabushiki Kaisha Eier||Adjustable position fixing apparatus for instrument and the like|
|US5480422||23 Sep 1994||2 Ene 1996||Biosense, Inc.||Apparatus for treating cardiac arrhythmias|
|US5497784||30 Jun 1994||12 Mar 1996||Intelliwire, Inc.||Flexible elongate device having steerable distal extremity|
|US5515478||13 Sep 1994||7 May 1996||Computer Motion, Inc.||Automated endoscope system for optimal positioning|
|US5520644||1 Jul 1993||28 May 1996||Intelliwire, Inc.||Flexible elongate device having steerable distal extremity and apparatus for use therewith and method|
|US5524180||3 Jun 1993||4 Jun 1996||Computer Motion, Inc.||Automated endoscope system for optimal positioning|
|US5540649||8 Oct 1993||30 Jul 1996||Leonard Medical, Inc.||Positioner for medical instruments|
|US5553198||29 Nov 1994||3 Sep 1996||Computer Motion, Inc.||Automated endoscope system for optimal positioning|
|US5572999||26 Ene 1995||12 Nov 1996||International Business Machines Corporation||Robotic system for positioning a surgical instrument relative to a patient's body|
|US5606979||28 May 1993||4 Mar 1997||The Microspring Company Inc.||Guide wire|
|US5618294||21 Jul 1995||8 Abr 1997||Aust & Taylor Medical Corporation||Surgical instrument|
|US5624398||8 Feb 1996||29 Abr 1997||Symbiosis Corporation||Endoscopic robotic surgical tools and methods|
|US5626553||29 Abr 1996||6 May 1997||Vision-Sciences, Inc.||Endoscope articulation system to reduce effort during articulation of an endoscope|
|US5626595||11 Oct 1994||6 May 1997||Automated Medical Instruments, Inc.||Automated surgical instrument|
|US5631973||5 May 1994||20 May 1997||Sri International||Method for telemanipulation with telepresence|
|US5632758||5 Jul 1994||27 May 1997||Automated Medical Instruments, Inc.||Automated surgical instrument|
|US5634897||8 Oct 1993||3 Jun 1997||Lake Region Manufacturing, Inc.||Rheolytic occlusion removal catheter system and method|
|US5636634||16 Mar 1993||10 Jun 1997||Ep Technologies, Inc.||Systems using guide sheaths for introducing, deploying, and stabilizing cardiac mapping and ablation probes|
|US5649956||7 Jun 1995||22 Jul 1997||Sri International||System and method for releasably holding a surgical instrument|
|US5657429||6 Jun 1995||12 Ago 1997||Computer Motion, Inc.||Automated endoscope system optimal positioning|
|US5667476||5 Jun 1995||16 Sep 1997||Vision-Sciences, Inc.||Endoscope articulation system to reduce effort during articulation of an endoscope|
|US5674279||29 Jun 1995||7 Oct 1997||Medtronic, Inc.||Annuloplasty and suture rings|
|US5754741||16 Dic 1996||19 May 1998||Computer Motion, Inc.||Automated endoscope for optimal positioning|
|US5759153||13 Nov 1996||2 Jun 1998||Cardiovascular Imaging Systems, Inc.||Automated longitudinal position translator for ultrasonic imaging probes, and methods of using same|
|US5762458 *||20 Feb 1996||9 Jun 1998||Computer Motion, Inc.||Method and apparatus for performing minimally invasive cardiac procedures|
|US5784542||23 Oct 1996||21 Jul 1998||California Institute Of Technology||Decoupled six degree-of-freedom teleoperated robot system|
|US5792135||16 May 1997||11 Ago 1998||Intuitive Surgical, Inc.||Articulated surgical instrument for performing minimally invasive surgery with enhanced dexterity and sensitivity|
|US5800333||20 Feb 1996||1 Sep 1998||United States Surgical Corporation||Afterloader provided with remote control unit|
|US5800423||20 Jul 1995||1 Sep 1998||Sri International||Remote center positioner with channel shaped linkage element|
|US5807377||16 May 1997||15 Sep 1998||Intuitive Surgical, Inc.||Force-reflecting surgical instrument and positioning mechanism for performing minimally invasive surgery with enhanced dexterity and sensitivity|
|US5808665||9 Sep 1996||15 Sep 1998||Sri International||Endoscopic surgical instrument and method for use|
|US5810880||1 May 1997||22 Sep 1998||Sri International||System and method for releasably holding a surgical instrument|
|US5814038||27 Mar 1997||29 Sep 1998||Sri International||Surgical manipulator for a telerobotic system|
|US5815640||31 Jul 1997||29 Sep 1998||Computer Motion, Inc.||Automated endoscope system for optimal positioning|
|US5821920||28 Mar 1997||13 Oct 1998||Immersion Human Interface Corporation||Control input device for interfacing an elongated flexible object with a computer system|
|US5823993||27 Nov 1995||20 Oct 1998||Lemelson; Jerome H.||Computer controlled drug injection system and method|
|US5825982||15 Sep 1995||20 Oct 1998||Wright; James||Head cursor control interface for an automated endoscope system for optimal positioning|
|US5827313||27 Sep 1996||27 Oct 1998||Boston Scientific Corporation||Device for controlled longitudinal movement of an operative element within a catheter sheath and method|
|US5828197||25 Oct 1996||27 Oct 1998||Immersion Human Interface Corporation||Mechanical interface having multiple grounded actuators|
|US5833656||3 Ene 1997||10 Nov 1998||Symbiosis Corporation||Endoscopic robotic surgical tools and methods|
|US5845646||5 Nov 1996||8 Dic 1998||Lemelson; Jerome||System and method for treating select tissue in a living being|
|US5855553||16 Feb 1996||5 Ene 1999||Hitchi, Ltd.||Remote surgery support system and method thereof|
|US5855583||22 Nov 1996||5 Ene 1999||Computer Motion, Inc.||Method and apparatus for performing minimally invasive cardiac procedures|
|US5860992||31 Ene 1996||19 Ene 1999||Heartport, Inc.||Endoscopic suturing devices and methods|
|US5861024||20 Jun 1997||19 Ene 1999||Cardiac Assist Devices, Inc||Electrophysiology catheter and remote actuator therefor|
|US5868755||16 Ene 1997||9 Feb 1999||Atrion Medical Products, Inc.||Sheath retractor mechanism and method|
|US5876325||30 Sep 1997||2 Mar 1999||Olympus Optical Co., Ltd.||Surgical manipulation system|
|US5878193||16 Oct 1996||2 Mar 1999||Computer Motion, Inc.||Automated endoscope system for optimal positioning|
|US5907664||11 Mar 1996||25 May 1999||Computer Motion, Inc.||Automated endoscope system for optimal positioning|
|US5928248||25 Feb 1998||27 Jul 1999||Biosense, Inc.||Guided deployment of stents|
|US5931832||20 Jul 1995||3 Ago 1999||Sri International||Methods for positioning a surgical instrument about a remote spherical center of rotation|
|US5954692||9 Jul 1997||21 Sep 1999||Symbiosis||Endoscopic robotic surgical tools and methods|
|US5957941||27 Sep 1996||28 Sep 1999||Boston Scientific Corporation||Catheter system and drive assembly thereof|
|US5964717||6 Ene 1997||12 Oct 1999||Symbiosis Corporation||Biopsy forceps having detachable handle and distal jaws|
|US5971976||28 Ene 1998||26 Oct 1999||Computer Motion, Inc.||Motion minimization and compensation system for use in surgical procedures|
|US5976122||25 Feb 1998||2 Nov 1999||Integrated Surgical Systems, Inc.||Articulated surgical instrument for performing minimally invasive surgery with enhanced dexterity and sensitivity|
|US6001108||30 Dic 1997||14 Dic 1999||Computer Motion, Inc.||Method and apparatus for performing minimally invasive cardiac procedures|
|US6007550||8 Oct 1998||28 Dic 1999||Computer Motion, Inc.||Method and apparatus for performing minimally invasive cardiac procedures|
|US6007560||16 Sep 1997||28 Dic 1999||Symbiosis Corporation||Biopsy forceps having detachable handle and distal jaws|
|US6024695||6 May 1999||15 Feb 2000||International Business Machines Corporation||System and method for augmentation of surgery|
|US6036636 *||13 Nov 1997||14 Mar 2000||Olympus Optical Co., Ltd.||Endoscope with tip portion disposed on distal side of insertion portion|
|US6058323||20 Ago 1997||2 May 2000||Lemelson; Jerome||System and method for treating select tissue in a living being|
|US6063095||18 Sep 1998||16 May 2000||Computer Motion, Inc.||Method and apparatus for performing minimally invasive surgical procedures|
|US6080170||19 Ene 1999||27 Jun 2000||Kensey Nash Corporation||System and method of use for revascularizing stenotic bypass grafts and other occluded blood vessels|
|US6080181||26 Jun 1998||27 Jun 2000||Sri International||System and method for releasably holding a surgical instrument|
|US6096004||10 Jul 1998||1 Ago 2000||Mitsubishi Electric Information Technology Center America, Inc. (Ita)||Master/slave system for the manipulation of tubular medical tools|
|US6102850||11 Jun 1997||15 Ago 2000||Computer Motion, Inc.||Medical robotic system|
|US6106511||8 Sep 1998||22 Ago 2000||Sri International||Methods and devices for positioning a surgical instrument at a surgical site|
|US6120433||14 Oct 1997||19 Sep 2000||Olympus Optical Co., Ltd.||Surgical manipulator system|
|US6126635||5 Jun 1995||3 Oct 2000||Advanced Cardiovascular Systems, Inc.||Adjustable treatment chamber catheter|
|US6132368||21 Nov 1997||17 Oct 2000||Intuitive Surgical, Inc.||Multi-component telepresence system and method|
|US6132441||7 Abr 1999||17 Oct 2000||Computer Motion, Inc.||Rigidly-linked articulating wrist with decoupled motion transmission|
|US6156005||16 Dic 1997||5 Dic 2000||Schneider (Europe) Gmbh||Ballon catheter for stent implantation|
|US6171234||25 Sep 1998||9 Ene 2001||Scimed Life Systems, Inc.||Imaging gore loading tool|
|US6179856||19 Dic 1997||30 Ene 2001||Medtronic Ave, Inc.||Coaxial PTCA catheter with anchor joint|
|US6197017||17 Ago 1999||6 Mar 2001||Brock Rogers Surgical, Inc.||Articulated apparatus for telemanipulator system|
|US6206903||8 Oct 1999||27 Mar 2001||Intuitive Surgical, Inc.||Surgical tool with mechanical advantage|
|US6221070||3 Jun 1998||24 Abr 2001||Irvine Biomedical, Inc.||Steerable ablation catheter system having disposable shaft|
|US6223100||25 Mar 1998||24 Abr 2001||Sri, International||Apparatus and method for performing computer enhanced surgery with articulated instrument|
|US6231565||18 Jun 1998||15 May 2001||United States Surgical Corporation||Robotic arm DLUs for performing surgical tasks|
|US6233504||14 Abr 1999||15 May 2001||California Institute Of Technology||Tool actuation and force feedback on robot-assisted microsurgery system|
|US6246200||3 Ago 1999||12 Jun 2001||Intuitive Surgical, Inc.||Manipulator positioning linkage for robotic surgery|
|US6269819||25 Jun 1998||7 Ago 2001||The Trustees Of Columbia University In The City Of New York||Method and apparatus for circulatory valve repair|
|US6283921||16 Jun 1997||4 Sep 2001||Intravascular Research Limited||Ultrasonic visualization and catheters therefor|
|US6290675||9 Ene 1998||18 Sep 2001||Endosonics Corporation||Device for withdrawing a catheter|
|US6292681||20 Dic 1999||18 Sep 2001||Boston Scientific Corporation||Combined motor drive and automated longitudinal position translator for ultrasonic imaging system|
|US6309397||2 Dic 1999||30 Oct 2001||Sri International||Accessories for minimally invasive robotic surgery and methods|
|US6312435||8 Oct 1999||6 Nov 2001||Intuitive Surgical, Inc.||Surgical instrument with extended reach for use in minimally invasive surgery|
|US6319227||5 Ago 1998||20 Nov 2001||Scimed Life Systems, Inc.||Automatic/manual longitudinal position translator and rotary drive system for catheters|
|US6325808||8 Dic 1998||4 Dic 2001||Advanced Realtime Control Systems, Inc.||Robotic system, docking station, and surgical tool for collaborative control in minimally invasive surgery|
|US6331181||15 Oct 1999||18 Dic 2001||Intuitive Surgical, Inc.||Surgical robotic tools, data architecture, and use|
|US6346072||28 Sep 1999||12 Feb 2002||Intuitive Surgical, Inc.||Multi-component telepresence system and method|
|US6352503 *||15 Jul 1999||5 Mar 2002||Olympus Optical Co., Ltd.||Endoscopic surgery apparatus|
|US6364888||7 Abr 1999||2 Abr 2002||Intuitive Surgical, Inc.||Alignment of master and slave in a minimally invasive surgical apparatus|
|US6369834||2 Jun 1999||9 Abr 2002||Massachusetts Institute Of Technology||Method and apparatus for determining forces to be applied to a user through a haptic interface|
|US6371907||13 Ago 1998||16 Abr 2002||Olympus Optical Co., Ltd.||Endoscope apparatus driving manipulation wires with drive motor in drum portion|
|US6375471||10 Jul 1998||23 Abr 2002||Mitsubishi Electric Research Laboratories, Inc.||Actuator for independent axial and rotational actuation of a catheter or similar elongated object|
|US6377011||26 Ene 2000||23 Abr 2002||Massachusetts Institute Of Technology||Force feedback user interface for minimally invasive surgical simulator and teleoperator and other similar apparatus|
|US6385509||15 May 2001||7 May 2002||California Institute Of Technology||Tool actuation and force feedback on robot-assisted microsurgery system|
|US6394998||17 Sep 1999||28 May 2002||Intuitive Surgical, Inc.||Surgical tools for use in minimally invasive telesurgical applications|
|US6398726||9 Nov 1999||4 Jun 2002||Intuitive Surgical, Inc.||Stabilizer for robotic beating-heart surgery|
|US6398755||24 May 1999||4 Jun 2002||Scimed Life Systems, Inc.||Driveable catheter system|
|US6432112||6 Abr 2001||13 Ago 2002||Brock Rogers Surgical, Inc.||Articulated apparatus for telemanipulator system|
|US6436107||3 Mar 1999||20 Ago 2002||Computer Motion, Inc.||Method and apparatus for performing minimally invasive surgical procedures|
|US6441577||3 Abr 2001||27 Ago 2002||Intuitive Surgical, Inc.||Manipulator positioning linkage for robotic surgery|
|US6451027||15 Dic 1999||17 Sep 2002||Intuitive Surgical, Inc.||Devices and methods for moving an image capture device in telesurgical systems|
|US6459926||17 Sep 1999||1 Oct 2002||Intuitive Surgical, Inc.||Repositioning and reorientation of master/slave relationship in minimally invasive telesurgery|
|US6463361||22 Sep 1994||8 Oct 2002||Computer Motion, Inc.||Speech interface for an automated endoscopic system|
|US6468265||9 Nov 1999||22 Oct 2002||Intuitive Surgical, Inc.||Performing cardiac surgery without cardioplegia|
|US6490490||10 Mar 2000||3 Dic 2002||Olympus Optical Co., Ltd.||Remote operation support system and method|
|US6491691||8 Oct 1999||10 Dic 2002||Intuitive Surgical, Inc.||Minimally invasive surgical hook apparatus and method for using same|
|US6491701||12 Ene 2001||10 Dic 2002||Intuitive Surgical, Inc.||Mechanical actuator interface system for robotic surgical tools|
|US6493608||7 Abr 1999||10 Dic 2002||Intuitive Surgical, Inc.||Aspects of a control system of a minimally invasive surgical apparatus|
|US6496099||15 Jul 1999||17 Dic 2002||Computer Motion, Inc.||General purpose distributed operating room control system|
|US6517565||22 Feb 2000||11 Feb 2003||Power Medical Interventions, Inc.||Carriage assembly for controlling a steering wire steering mechanism within a flexible shaft|
|US6522906||14 Dic 1999||18 Feb 2003||Intuitive Surgical, Inc.||Devices and methods for presenting and regulating auxiliary information on an image display of a telesurgical system to assist an operator in performing a surgical procedure|
|US6554844||6 Abr 2001||29 Abr 2003||Endovia Medical, Inc.||Surgical instrument|
|US6565554||7 Abr 1999||20 May 2003||Intuitive Surgical, Inc.||Friction compensation in a minimally invasive surgical apparatus|
|US6587750||25 Sep 2001||1 Jul 2003||Intuitive Surgical, Inc.||Removable infinite roll master grip handle and touch sensor for robotic surgery|
|US6594552||6 Abr 2000||15 Jul 2003||Intuitive Surgical, Inc.||Grip strength with tactile feedback for robotic surgery|
|US6620173||31 May 2001||16 Sep 2003||Intuitive Surgical, Inc.||Method for introducing an end effector to a surgical site in minimally invasive surgery|
|US6645196||16 Jun 2000||11 Nov 2003||Intuitive Surgical, Inc.||Guided tool change|
|US6676684||4 Sep 2001||13 Ene 2004||Intuitive Surgical, Inc.||Roll-pitch-roll-yaw surgical tool|
|US6685698||10 Ene 2003||3 Feb 2004||Intuitive Surgical, Inc.||Roll-pitch-roll surgical tool|
|US6692485||21 Dic 2000||17 Feb 2004||Endovia Medical, Inc.||Articulated apparatus for telemanipulator system|
|US6699235||28 Jun 2002||2 Mar 2004||Intuitive Surgical, Inc.||Platform link wrist mechanism|
|US6720988||20 Ago 1999||13 Abr 2004||Intuitive Surgical, Inc.||Stereo imaging system and method for use in telerobotic systems|
|US6726675 *||9 Mar 1999||27 Abr 2004||Navicath Ltd.||Remote control catheterization|
|US6726699||15 Ago 2000||27 Abr 2004||Computer Motion, Inc.||Instrument guide|
|US6728599||7 Sep 2001||27 Abr 2004||Computer Motion, Inc.||Modularity system for computer assisted surgery|
|US6770081||7 Ene 2000||3 Ago 2004||Intuitive Surgical, Inc.||In vivo accessories for minimally invasive robotic surgery and methods|
|US6783524||18 Abr 2002||31 Ago 2004||Intuitive Surgical, Inc.||Robotic surgical tool with ultrasound cauterizing and cutting instrument|
|US6788018||20 Dic 2001||7 Sep 2004||Intuitive Surgical, Inc.||Ceiling and floor mounted surgical robot set-up arms|
|US6793652||28 Nov 2000||21 Sep 2004||Power Medical Interventions, Inc.||Electro-mechanical surgical device|
|US6793653||8 Dic 2001||21 Sep 2004||Computer Motion, Inc.||Multifunctional handle for a medical robotic system|
|US6799065||7 Dic 1999||28 Sep 2004||Intuitive Surgical, Inc.||Image shifting apparatus and method for a telerobotic system|
|US6817972||29 May 2001||16 Nov 2004||Computer Motion, Inc.||Heart stabilizer|
|US6817974||28 Jun 2002||16 Nov 2004||Intuitive Surgical, Inc.||Surgical tool having positively positionable tendon-actuated multi-disk wrist joint|
|US6837883||5 Oct 2001||4 Ene 2005||Intuitive Surgical, Inc.||Arm cart for telerobotic surgical system|
|US6840938||21 Dic 2001||11 Ene 2005||Intuitive Surgical, Inc.||Bipolar cauterizing instrument|
|US6852107||16 Ene 2002||8 Feb 2005||Computer Motion, Inc.||Minimally invasive surgical training using robotics and tele-collaboration|
|US6860877||29 Sep 2000||1 Mar 2005||Computer Motion, Inc.||Heart stabilizer support arm|
|US6911916||13 Jul 2000||28 Jun 2005||The Cleveland Clinic Foundation||Method and apparatus for accessing medical data over a network|
|US6936001||1 Oct 1999||30 Ago 2005||Computer Motion, Inc.||Heart stabilizer|
|US6936056||31 Ene 2003||30 Ago 2005||Kensey Nash Corporation||Intravascular system for occluded blood vessels and guidewire for use therein|
|US6951535||17 Sep 2002||4 Oct 2005||Intuitive Surgical, Inc.||Tele-medicine system that transmits an entire state of a subsystem|
|US6994708||18 Abr 2002||7 Feb 2006||Intuitive Surgical||Robotic tool with monopolar electro-surgical scissors|
|US7025064||6 Nov 2002||11 Abr 2006||Intuitive Surgical Inc||Method and apparatus for performing minimally invasive cardiac procedures|
|US7090683 *||16 Nov 2001||15 Ago 2006||Hansen Medical, Inc.||Flexible instrument|
|US20020087151||29 Dic 2000||4 Jul 2002||Afx, Inc.||Tissue ablation apparatus with a sliding ablation instrument and method|
|EP0683016A1||16 May 1995||22 Nov 1995||D.T.I. Dr. TRIPPE INGENIEURGES. mbH.||Supporting system for a flexible arm whose elements can be moved in space at will|
|EP0776738A2||14 Ene 1993||4 Jun 1997||Sri International||An endoscopic surgical instrument|
|1||Ikuta, et al., "Shape Memory Alloy Servo Actuator System With Electric Resistance Feedback and Application for Active Endoscope", 1988 IEEE, CH2555-1/88/0000/0427-430.|
|2||Thring, M.W., "Robots and Telechirs: Manipulators With Memory; Remote Manipulators; Machine Limbs for the Handicapped", First published in 1983 by Ellis Horwood Limited.|
|Patente citante||Fecha de presentación||Fecha de publicación||Solicitante||Título|
|US8353487||17 Dic 2009||15 Ene 2013||Ethicon Endo-Surgery, Inc.||User interface support devices for endoscopic surgical instruments|
|US8361112||27 Jun 2008||29 Ene 2013||Ethicon Endo-Surgery, Inc.||Surgical suture arrangement|
|US8403926||5 Jun 2008||26 Mar 2013||Ethicon Endo-Surgery, Inc.||Manually articulating devices|
|US8409200||3 Sep 2008||2 Abr 2013||Ethicon Endo-Surgery, Inc.||Surgical grasping device|
|US8425505||25 Ago 2011||23 Abr 2013||Ethicon Endo-Surgery, Inc.||Electroporation ablation apparatus, system, and method|
|US8449538||27 Ene 2010||28 May 2013||Ethicon Endo-Surgery, Inc.||Electroporation ablation apparatus, system, and method|
|US8480657||31 Oct 2007||9 Jul 2013||Ethicon Endo-Surgery, Inc.||Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ|
|US8496574||17 Dic 2009||30 Jul 2013||Ethicon Endo-Surgery, Inc.||Selectively positionable camera for surgical guide tube assembly|
|US8506564||18 Dic 2009||13 Ago 2013||Ethicon Endo-Surgery, Inc.||Surgical instrument comprising an electrode|
|US8579897||21 Nov 2007||12 Nov 2013||Ethicon Endo-Surgery, Inc.||Bipolar forceps|
|US8608652||5 Nov 2009||17 Dic 2013||Ethicon Endo-Surgery, Inc.||Vaginal entry surgical devices, kit, system, and method|
|US8652129||21 Ago 2009||18 Feb 2014||Medtronic Ardian Luxembourg S.A.R.L.||Apparatus, systems, and methods for achieving intravascular, thermally-induced renal neuromodulation|
|US8679003||30 May 2008||25 Mar 2014||Ethicon Endo-Surgery, Inc.||Surgical device and endoscope including same|
|US8728075||30 Ago 2010||20 May 2014||Medtronic Ardian Luxembourg S.A.R.L.||Multi-directional deflectable catheter apparatuses, systems, and methods for renal neuromodulation|
|US8771260||30 May 2008||8 Jul 2014||Ethicon Endo-Surgery, Inc.||Actuating and articulating surgical device|
|US8774913||14 Nov 2006||8 Jul 2014||Medtronic Ardian Luxembourg S.A.R.L.||Methods and apparatus for intravasculary-induced neuromodulation|
|US8777942||22 Oct 2010||15 Jul 2014||Medtronic Ardian Luxembourg S.A.R.L.||Apparatus, systems, and methods for achieving intravascular, thermally-induced renal neuromodulation|
|US8870863||28 May 2010||28 Oct 2014||Medtronic Ardian Luxembourg S.A.R.L.||Catheter apparatuses, systems, and methods for renal neuromodulation|
|US8906035||4 Jun 2008||9 Dic 2014||Ethicon Endo-Surgery, Inc.||Endoscopic drop off bag|
|US8939897||4 Feb 2011||27 Ene 2015||Ethicon Endo-Surgery, Inc.||Methods for closing a gastrotomy|
|US9005198||29 Ene 2010||14 Abr 2015||Ethicon Endo-Surgery, Inc.||Surgical instrument comprising an electrode|
|US9011431||4 Sep 2012||21 Abr 2015||Ethicon Endo-Surgery, Inc.||Electrical ablation devices|
|US9028483||18 Dic 2009||12 May 2015||Ethicon Endo-Surgery, Inc.||Surgical instrument comprising an electrode|
|US9049987||15 Mar 2012||9 Jun 2015||Ethicon Endo-Surgery, Inc.||Hand held surgical device for manipulating an internal magnet assembly within a patient|
|US9078662||3 Jul 2012||14 Jul 2015||Ethicon Endo-Surgery, Inc.||Endoscopic cap electrode and method for using the same|
|US9125661||17 Oct 2013||8 Sep 2015||Medtronic Ardian Luxembourg S.A.R.L.||Methods and apparatus for renal neuromodulation|
|US9131978||23 Abr 2014||15 Sep 2015||Medtronic Ardian Luxembourg S.A.R.L.||Methods for bilateral renal neuromodulation|
|US20080243064 *||15 Feb 2008||2 Oct 2008||Hansen Medical, Inc.||Support structure for robotic medical instrument|
|US20080262480 *||15 Feb 2008||23 Oct 2008||Stahler Gregory J||Instrument assembly for robotic instrument system|
|US20090112062 *||31 Oct 2007||30 Abr 2009||Bakos Gregory J||Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ|
|US20090131932 *||21 Nov 2007||21 May 2009||Vakharia Omar J||Bipolar forceps having a cutting element|
|US20100198248 *||2 Feb 2009||5 Ago 2010||Ethicon Endo-Surgery, Inc.||Surgical dissector|
|Clasificación de EE.UU.||600/114, 604/95.04, 606/1|
|Clasificación internacional||A61B5/04, A61B17/00, A61B17/04, A61B5/00, A61B17/28, B25J9/10, A61B1/00, A61B19/00, B25J3/04|
|Clasificación cooperativa||A61B2017/00477, A61B2019/5291, A61B2019/2211, A61B2019/2246, A61B2019/2242, A61B2017/00331, B25J3/04, A61B17/3462, A61B17/0469, A61B5/4893, A61B5/0084, A61B2019/265, A61B19/2203, A61B2019/5259, A61B19/5244, A61B2019/2223, A61B19/50, A61B19/5212, A61B2019/2276, A61B19/52, A61B2017/00026, A61B5/015, A61B17/00234, A61B2019/5276, A61B2017/00088, A61B17/29, A61B17/0483, A61B2019/223, A61B2017/003, A61B17/3421, B25J9/104, A61B2019/5251, A61B2019/2249, A61B19/22, A61B2017/2927, A61B2019/2234, A61B2019/2296, A61B2019/2284, A61B2017/2939|
|Clasificación europea||B25J3/04, A61B17/04H, B25J9/10C, A61B17/04E, A61B19/52, A61B19/52H12, A61B19/22, A61B19/22B|